A CHANGE OF HEART: THE EFFECT OF HIGH FLOW ARTERIOVENOUS FISTULAS ON CARDIOVASCULAR OUTCOMES – A SYSTEMATIC REVIEW AND SYNTHESIS WITHOUT META-ANALYSIS (SWiM)
Ms. Morgan Hind1, Professor Zoltan Endre2,3, Dr. Blake Cochran4, Professor Tracie Barber5, Dr. Jonathan Erlich2,3, Dr Nasir Shah2,3
1School of Medicine, University of Notre Dame Australia, Sydney, Australia, 2School of Clinical Medicine, Faculty of Medicine & Health, UNSW Sydney, Sydney, Australia, 3Department of Nephrology, Prince of Wales Hospital, Randwick, Australia, 4School of Biomedical Sciences, Faculty of Medicine & Health, UNSW Sydney, Sydney, Australia, 5School of Mechanical and Manufacturing Engineering, Faculty of Engineering, UNSW Sydney, Sydney, Australia
Aim: To describe the relationship between arteriovenous fistula (AVF) flow and cardiac outcomes.
Background: Heart failure is a common cardiovascular condition in patients on haemodialysis. Case reports and a selection of studies have found associations between AVF flow and heart failure, but the exact relationship remains unclear.
Methods: A comprehensive search of the PubMed, EMBASE, and Cochrane databases was used to identify observational studies and randomized controlled trials reporting an effect of AVF flow on cardiac outcomes (clinical, echocardiographic, and biomarker). Due to study heterogeneity, meta-analysis was not feasible. Synthesis without meta-analysis (SWiM) was performed using vote counting of direction of effect as the primary outcome.
Results: The initial search strategy retrieved 3622 studies. After screening, 100 studies were analysed including a total of 8414 patients. A positive direction of effect was observed with cardiac output (29/34 studies), BNP (13/18 studies), ANP (2/3 studies), left ventricular hypertrophy and left ventricular mass (10/15 studies), left ventricular mass index (11/19 studies), left atrial volume index (10/12 studies) and incident heart failure or heart failure symptoms (21/25 studies). A neutral direction of effect was observed with ejection fraction (29/41 studies), E/A ratio (13/13 studies), E/E’ ratio (8/11 studies), tricuspid annular plane systolic excursion (6/9 studies), and measures of pulmonary hypertension (13/26 studies). A negative direction of effect was observed for all-cause mortality (3/7 studies).
Conclusions: This systematic review and synthesis without meta-analysis showed a positive relationship between AVF flow and several cardiovascular outcomes, but an inverse relationship between AVF flow and mortality. The methodological heterogeneity of studies highlights the need for well-designed prospective research with standardised definitions of high flow AVFs and measures for reporting of cardiovascular outcomes.
Biography:
Morgan Hind has a Bachelor of Science (Medical Science, Neuroscience) from the University of Sydney. She is now in her third year of her Medical Doctorate at The University of Notre Dame.